Personal Information

Notice

By filling out this application, you are authorizing the Town to contact your former or current employers (unless you specifically indicate they can’t be contacted) or other references, as well as any educational institutions listed. All of them are authorized to release any information they may have about you; you agree to release the Town and its employees, as well as all references, from any liability which may result or be claimed because of the information provided (or because of the fact that any information was provided). You further agree to defend and hold harmless the Town of Pinetop-Lakeside and any references or educational institutions from any claims, demands, lawsuits, judgments, or other liability relating to the information provided.

Position Applied For*

Applicant's Name*

Mailing Address*

Phone Number*

Message Phone

Email Address

Upload Resume (Optional)

Are you over 18 years of age?*

Yes

No

Are you legally eligible to work in the United States?*

Yes

No

Other

If other, please explain.

Types of employment you will accept:*

Check all that apply.

Regular Full-Time

Regular Part-Time

Temporary Full-Time

Temporary Part-Time

Temporary / On-Call

Which shifts can you work?*

Check all that apply.

Days

Evenings

Nights

Rotating

Are you able to work weekends?*

Check all that apply.

Days

Evenings

Nights

Rotating

How did you learn of this position?

Are you a U.S. Citizen, or do you have the legal right to remain permanently in the U.S.?*

Yes

No

If you are required to drive a Town vehicle, do you possess a current valid driver's license?*

All applicants are required to posses a current Class B Commercial Driver's License at time of employment or with-in 6 months of date of hire.

Yes

No

In what state was your driver's license issued?*

What class of driver's license you currently have?*

Driver's License Number:*

Driver's License Expiration Date:

Driver's License Expiration Date:

Have you ever worked for the Town of Pinetop-Lakeside before?*

Yes

No

If yes, when?

Are any of your relatives currently employed by the Town of Pinetop-Lakeside?*

Yes

No

Who? How are they related? What position do they hold?

Have you ever been discharged, or requested or forced to resign from any position?*

Yes

No

If yes, please explain.

Do you have any reason to believe you will be discharged or requested to resign from your current position within the next thirty days?*

Additional Comments & Signature

Do you have any additional comments regarding your application?

Electronic Signature Agreement*

By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.